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General NPI Number Information
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NPI Number | 1417049396
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Entity Type | Individual
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Provider Name | DAVID MARK KING M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 480 OSBORNE RD NE SUITE 220
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City | FRIDLEY
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State | MN
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Zip | 55432-2281
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Country | US
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Telephone | 763-786-1620
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Fax | 763-780-3099
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Provider Business Mailing Address
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Address Line | 2550 UNIVERSITY AVE W STE 110N
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City | SAINT PAUL
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State | MN
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Zip | 55114-2001
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Country | US
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Telephone | 651-602-5309
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Fax | 651-222-6786
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 45762
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License Number State | MN
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